Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 7, Section: Growth Measurement
Question Stem:
A 4-month-old infant is brought to the clinic for a well-child
visit. The infant was born at 38 weeks gestation. The nurse
practitioner plots the infant's weight and notes it has crossed
two percentile lines downward on the growth chart since the
2-month visit. What is the most appropriate initial action by
the nurse practitioner?
Options:
A. Reassure the parents that this is a normal variation in infant
growth patterns.
B. Obtain a detailed 24-hour diet history, including
,breastfeeding technique or formula preparation.
C. Order a complete blood count and comprehensive
metabolic panel to screen for organic disease.
D. Refer the infant immediately to a pediatric
gastroenterologist for further evaluation.
Correct Answer: B
Rationales:
• Correct: A downward crossing of two or more major
percentile lines is a strong indicator of Failure to Thrive
(FTT) or undernutrition. The initial and most crucial step
is a detailed nutritional assessment to identify potential
caloric deficits, feeding problems, or psychosocial issues
before pursuing invasive testing.
• Incorrect A: While growth can vary, crossing two
percentile lines is a red flag and not a normal variation,
requiring investigation.
• Incorrect C: Laboratory studies are not the first-line step
for evaluating FTT; they are typically reserved for cases
where dietary intervention fails or a specific organic
cause is suspected based on history or physical exam.
• Incorrect D: Referral to a specialist is premature before a
primary care evaluation, including a thorough feeding
and dietary history, is completed.
,Teaching Point: A downward crossing of two growth
percentiles warrants an immediate, detailed nutritional
assessment.
Question 2
Reference: Ch. 8, Section: Developmental Surveillance and
Screening
Question Stem:
During a 9-month well-child visit, the parents report no
concerns. The nurse practitioner observes the infant sitting
without support, transferring a toy from one hand to the
other, and using a raking grasp. There is no babbling of
"mama" or "dada." Based on developmental surveillance,
what is the most appropriate next step?
Options:
A. Document the findings as normal for age and schedule the
12-month visit.
B. Administer a formal, standardized developmental screening
tool.
C. Provide parental education on the importance of reading to
the infant to encourage language.
D. Refer the infant for a formal audiologic evaluation.
Correct Answer: B
Rationales:
, • Correct: The absence of canonical babbling (repetitive
consonants like "mama," "baba") by 9 months is a
potential red flag for language delay. When a potential
delay is identified through surveillance, the next step is to
conduct a standardized developmental screen to
objectively assess all domains.
• Incorrect A: The lack of babbling is a deviation from
expected milestones and requires further action, not just
documentation.
• Incorrect C: While reading is always beneficial, it does not
address the need for a formal assessment of the
identified potential delay.
• Incorrect D: A hearing evaluation may be needed, but it is
premature before a standardized developmental screen is
performed to quantify the delay.
Teaching Point: The absence of canonical babbling by 9
months triggers the need for a formal developmental screen.
Question 3
Reference: Ch. 24, Section: Acute Otitis Media (AOM)
Question Stem:
A previously healthy, fully immunized 2-year-old presents with
48 hours of fussiness and tugging at the ear. The tympanic
membrane is bulging, erythematous, and has limited mobility
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 7, Section: Growth Measurement
Question Stem:
A 4-month-old infant is brought to the clinic for a well-child
visit. The infant was born at 38 weeks gestation. The nurse
practitioner plots the infant's weight and notes it has crossed
two percentile lines downward on the growth chart since the
2-month visit. What is the most appropriate initial action by
the nurse practitioner?
Options:
A. Reassure the parents that this is a normal variation in infant
growth patterns.
B. Obtain a detailed 24-hour diet history, including
,breastfeeding technique or formula preparation.
C. Order a complete blood count and comprehensive
metabolic panel to screen for organic disease.
D. Refer the infant immediately to a pediatric
gastroenterologist for further evaluation.
Correct Answer: B
Rationales:
• Correct: A downward crossing of two or more major
percentile lines is a strong indicator of Failure to Thrive
(FTT) or undernutrition. The initial and most crucial step
is a detailed nutritional assessment to identify potential
caloric deficits, feeding problems, or psychosocial issues
before pursuing invasive testing.
• Incorrect A: While growth can vary, crossing two
percentile lines is a red flag and not a normal variation,
requiring investigation.
• Incorrect C: Laboratory studies are not the first-line step
for evaluating FTT; they are typically reserved for cases
where dietary intervention fails or a specific organic
cause is suspected based on history or physical exam.
• Incorrect D: Referral to a specialist is premature before a
primary care evaluation, including a thorough feeding
and dietary history, is completed.
,Teaching Point: A downward crossing of two growth
percentiles warrants an immediate, detailed nutritional
assessment.
Question 2
Reference: Ch. 8, Section: Developmental Surveillance and
Screening
Question Stem:
During a 9-month well-child visit, the parents report no
concerns. The nurse practitioner observes the infant sitting
without support, transferring a toy from one hand to the
other, and using a raking grasp. There is no babbling of
"mama" or "dada." Based on developmental surveillance,
what is the most appropriate next step?
Options:
A. Document the findings as normal for age and schedule the
12-month visit.
B. Administer a formal, standardized developmental screening
tool.
C. Provide parental education on the importance of reading to
the infant to encourage language.
D. Refer the infant for a formal audiologic evaluation.
Correct Answer: B
Rationales:
, • Correct: The absence of canonical babbling (repetitive
consonants like "mama," "baba") by 9 months is a
potential red flag for language delay. When a potential
delay is identified through surveillance, the next step is to
conduct a standardized developmental screen to
objectively assess all domains.
• Incorrect A: The lack of babbling is a deviation from
expected milestones and requires further action, not just
documentation.
• Incorrect C: While reading is always beneficial, it does not
address the need for a formal assessment of the
identified potential delay.
• Incorrect D: A hearing evaluation may be needed, but it is
premature before a standardized developmental screen is
performed to quantify the delay.
Teaching Point: The absence of canonical babbling by 9
months triggers the need for a formal developmental screen.
Question 3
Reference: Ch. 24, Section: Acute Otitis Media (AOM)
Question Stem:
A previously healthy, fully immunized 2-year-old presents with
48 hours of fussiness and tugging at the ear. The tympanic
membrane is bulging, erythematous, and has limited mobility
